Provider Demographics
NPI:1407181548
Name:WEBSTER, KENNETH ARVID (DMD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ARVID
Last Name:WEBSTER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 BANDERA RD
Mailing Address - Street 2:
Mailing Address - City:LEON VALLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78238-1986
Mailing Address - Country:US
Mailing Address - Phone:210-521-1733
Mailing Address - Fax:
Practice Address - Street 1:5601 BANDERA RD
Practice Address - Street 2:
Practice Address - City:LEON VALLEY
Practice Address - State:TX
Practice Address - Zip Code:78238-1986
Practice Address - Country:US
Practice Address - Phone:210-521-1733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX250131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice